Although a range of neurosurgical procedures is available for the management of spasticity, none have gained acceptance in the context of MS. There are relatively few data available to evaluate potential benefit, but some retrospective analyses of clinical series suggest that at least selective posterior rhizotomy may have a role.

In the view of the Committee, spasticity is a very disabling symptom that often is poorly managed. There is a range of treatment options that have a moderate evidence base, although none have shown absolute or comparative efficacy in a recent Cochrane review. However, a coordinated approach to management is essential, and there is a need for more effective oral agents with a better side-effect profile.